Lincoln Highway Association: Become a Member

Print out this page, fill it out the application, and mail it to:

Lincoln Highway Association - Treasurer
P.O. Box 1075
Tooele, UT 84074-1075

Date: ____________________    Annual membership is from date of enrollment.

( ) New Membership        ( ) Renewal

Membership Categories:

( ) Student:* $25
( ) Individual: $45
( ) Family: $60
( ) Libraries, museums & historical societies: $45
( ) Local, state, and county governments: $45
( ) Supporting: $75
( ) Patron: $150
( ) Business: $75
( ) Corporate: $150
( ) Life: $1000 and up

* Students: include copy of front and back of student ID card

State Affiliation

Members who live in Lincoln Highway states are automatically members of that state's chapter. Dues for additional chapter memberships are $9.00 per year per state. Check the appropriate box. [ ] NY
[ ] IN
[ ] CO
[ ] NJ
[ ] IL
[ ] UT
[ ] PA
[ ] IA
[ ] NV
[ ] WV
[ ] NE
[ ] CA
[ ] OH
[ ] WY

If you would like to serve on a committee, which one?

[ ] Awards
[ ] Bylaws
[ ] Conference
[ ] Fund Raising
[ ] Government Relations
[ ] Highway Preservation & Interpretive Sites
[ ] Historic & Contemporary Markers
[ ] Historic Resources
[ ] Marketing
[ ] Nominating
[ ] Public Relations
[ ] Headquarters

Please Print

Name ____________________
Address ____________________
City _________ State __ Zip _____
Home phone (__) ___________
Work phone (__) ___________
Fax (__) ___________
E-mail address ______________

What do/did you do for a living? _____________________________________

The Lincoln Highway Association is exclusively charitable and educational, within the interpretation of Section 501(c)(3) of the Internal Revenue Code.

Payment Method:

( ) Check (payable to Lincoln Highway Association)     

Credit card: ( ) Visa          ( ) MasterCard          ( ) Discover

Name on card (if other than above): ________________
Address on card (if other than above): ________________
Card number (16 digits): ________________
CVV code (What is my CVV code?): _____
Expiration Date: ___ / ___
Signature: ________________

Copyright © 1999-2013 by the Lincoln Highway Association.